Perioperative Management and Nutrition in Patients With Liver and Biliary Tract Disease

Even a seemingly innocuous surgical procedure can lead to a catastrophic cascade of complications in the patient with significant underlying liver or biliary disease. The spectrum of portal hypertension, ascites, synthetic dysfunction, coagulopathy, hypersplenism, cholestasis, or biliary obstruction can all be present to varying degrees and should temper enthusiasm for surgical intervention. Liver and biliary tract disease sec- ondarily alter the physiology of other organ systems and create issues that must be considered when planning even the smallest operation, lest an otherwise routine surgical procedure precipitate bleeding, hypotension, and hepatic decompensation. Risks are difficult to quantify, but are related to the degree of underlying dysfunction as well as the magnitude of the anticipated procedure. All phases of perioperative care can be affected. This chapter will focus on the perioperative issues related to patients with various degrees of dysfunction caused by primary liver disease and the consequences of biliary obstruction.